cognitive behavioral therapy for children with pandas pans
Download
Skip this Video
Download Presentation
COGNITIVE BEHAVIORAL THERAPY FOR CHILDREN WITH PANDAS/PANS

Loading in 2 Seconds...

play fullscreen
1 / 27

COGNITIVE BEHAVIORAL THERAPY FOR CHILDREN WITH PANDAS/PANS - PowerPoint PPT Presentation


  • 314 Views
  • Uploaded on

COGNITIVE BEHAVIORAL THERAPY FOR CHILDREN WITH PANDAS/PANS. Brad Riemann, Ph.D. Clinical Director, OCD Center and CBT Services Rogers Memorial Hospital. BRAD RIEMANN. Clinical psychologists. Clinical Director, OCD Center at Rogers Memorial Hospital.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' COGNITIVE BEHAVIORAL THERAPY FOR CHILDREN WITH PANDAS/PANS' - ailis


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
cognitive behavioral therapy for children with pandas pans

COGNITIVE BEHAVIORAL THERAPY FOR CHILDREN WITH PANDAS/PANS

Brad Riemann, Ph.D.

Clinical Director, OCD Center and CBT Services

Rogers Memorial Hospital

brad riemann
BRAD RIEMANN
  • Clinical psychologists.
  • Clinical Director, OCD Center at Rogers Memorial Hospital.
  • Chair, Clinical Advisory Committee of IOCDF.
  • Member of Scientific Advisory Board of IOCDF.
  • Member of Clinical Advisory Board of ADAA.
introduction
INTRODUCTION
  • Overview of cognitive behavioral therapy (CBT) for obsessive compulsive disorder (OCD).
    • Components of CBT.
    • Keys to making exposure successful.
    • Thought challenging.
    • Assessment.
    • General outcomes.
  • Role of CBT for PANDAS/PANS.
    • Role of family in treatment.
    • Storch et al., 2006.
rogers memorial hospital ocd center
Rogers Memorial Hospital OCD Center
  • Private, free standing nonprofit psychiatric facility.
  • 7th largest behavioral health care system in U.S.
  • Levels of care for child and adults.
    • Intensive outpatient (12 hours per week).
    • Day treatment (20 hours per week).
    • Residential (30 hours per week).
cbt for ocd
CBT FOR OCD
  • CBT, alone or in combination with sertraline, is first line treatment for pediatric OCD (POTS Team, 2004).
cbt components
CBT COMPONENTS
  • Behavior Therapy (Exposure and Ritual Prevention; ERP).
    • Key element to effective treatment for OCD.
    • Meyer (1966).
    • Based on the principle of habituation.
    • Habituation is the decrease in anxiety experienced with nothing but the passage of time.
  • Cognitive restructuring (Thought Challenging).
    • Targets errors in thinking.
    • Use as an addition to ERP (85% - 15% split).
exposures and keys to success
EXPOSURES AND KEYS TO SUCCESS
  • Exposure is placing an individual in feared situations (targets the obsessions).
  • Needs to be prolonged enough to lead to within trial habituation (at least 50% reduction in anxiety).
  • Needs to be repetitive enough to lead to between trial habituation (until causes minimal to no anxiety).
  • Needs to be graduated (increases compliance).
    • We start people off in their 3’s (just below midpoint of 0-7 scale).
ritual prevention
RITUAL PREVENTION
  • Blocking the typical response or ritual before, during, and after exposure so habituation can take place (targets compulsions).
thought challenging
THOUGHT CHALLENGING
  • Global targets.
    • Increasing tolerance of uncertainty.
    • Decreasing perceived need to control thoughts (e.g., suppression of unwanted thoughts).
    • Decreasing the perceived importance of thoughts.
  • Specific targets.
    • Probability overestimation errors (e.g., getting HIV from touching a door handle).
    • Catastrophizing errors (e.g., someone in men’s room didn’t wash their hands after using toilet).
assessment
ASSESSMENT
  • Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; Goodman et al., 1989).
    • 60 symptom checklist.
      • Self-report version.
      • Childhood version (CY-BOCS).
    • 10 item severity rating scale (0-4).
      • 5 questions regarding obsessions.
      • 5 questions regarding compulsions.
      • Mean score for OCD = 24.
ybocs
YBOCS
  • 0- 7 = subclinical.
  • 8-15 = mild.
  • 16-23 = moderate (16 trial cut-off).
  • 24-31 = severe.
  • 32-40 = extreme.
treatment steps for erp
TREATMENT STEPS FOR ERP
  • CYBOCS symptom checklist.
    • Yes or no.
  • Detailed information gathering.
    • Generate lists of things can not do as a result.
  • Create specific, individualized exposure exercises for each area.
  • Rate each specific exercise on a “subjective units of distress scale” (SUDS; Rogers uses 0-7 scale).
  • Create exposure hierarchy.
  • Assign ERP assignments.
outcomes in general
OUTCOMES IN GENERAL
  • Effective (80-85% improvement rates; Foa et al., 1996a) and robust (low relapse rates, Foa et al., 1996b).
  • “Only” side effect is increased anxiety during treatment (can manage by conducting graduated exposure).
  • Quick improvements (many after first week of treatment).
the role of cbt in pandas pans
THE ROLE OF CBT IN PANDAS/PANS?
  • Reduce acute impairment and symptomology.
  • Prepare and empower parents and child for potential future symptom exacerbations.
  • Not a lot of data as of yet (larger samples being collected).
how cbt differs in pandas pans
HOW CBT DIFFERS IN PANDAS/PANS
  • It generally does not…
  • However, you have to consider potential factors:
    • Symptom severity.
    • Family factors.
    • Potential for future symptom exacerbations.
symptom severity
SYMPTOM SEVERITY
  • Symptoms may be extremely severe shortly after an exacerbation/onset of PANDAS/PANS.
    • Determine realistic timing of intervention.
    • May have to move more slowly through hierarchy.
    • May have to start lower than 3’s.
family factors and accommodation
FAMILY FACTORS AND ACCOMMODATION
  • Dramatic onset of symptoms changes family functioning considerably.
    • How are the parent/family doing?
  • As a result “ family accommodations” may be made in an attempt to cope with and reduce symptoms.
    • Unfortunately has opposite effect (makes things worse).
  • Treatment model is to train “parents as therapists”.
    • Address family accommodation in the course of treatment.
    • Always include parents in session.
potential for future exacerbations
POTENTIAL FOR FUTURE EXACERBATIONS
  • Although good probability for response, symptoms may return.
  • CBT provides family with a tool set for addressing such occurrences.
    • Empowering families.
    • Able to sort out what to do next should symptoms return.
  • May reduce severity of future episodes.
outcome data
OUTCOME DATA
  • Case report of CBT for rapid onset pediatric OCD of the PANDAS phenotype in a six-year-old boy. (Storch et al., 2004).
    • Over a one-week intensive CBT protocol, marked symptom reductions measured by the CY-BOCS were found (pre-treatment of 34 (extreme), post-treatment of 8 (low mild); treatment gains were maintained for one-year.
  • Considerable clinical experience from several centers around country (Rogers, USF).
storch et al 2006
STORCH ET AL. (2006)
  • PARTICIPANTS.
    • Seven children with PANDAS related OCD.
    • Aged 9-13 years.
    • 4 males, 3 females.
    • CY-BOCS total score ≥ 16.
    • Stable on all medication at least 8 weeks prior to study.
slide21

Subject

Age/Gender

Primary Obsessions

Primary Compulsions

1.

10-year-old female

Contamination fears

Aggressive thoughts

Somatic

Washing/Cleaning

Checking

Ordering/arranging

Reassurance seeking

2.

10-year-old male

Contamination fears

Aggressive thoughts

Sexual thoughts

Washing/Cleaning

Repeating

Counting

Reassurance seeking

3.

12-year-old male

Contamination fears

Washing/Cleaning

4.

11-year-old female

Contamination fears

Aggressive thoughts

Magical thoughts

Washing/Cleaning

Checking

Ordering/Arranging

Reassurance seeking

5.

13-year-old male

Contamination fears

Aggressive thoughts

Washing/Cleaning

Checking

Ordering/ Arranging

6.

9-year-old male

Contamination fears

Somatic fears

Washing/ Cleaning

Checking

Ordering/Arranging

Reassurance seeking

7.

11-year-old female

Contamination fears

Washing/Cleaning

Checking

Ordering/arranging

Reassurance seeking

Clinical Presentation

procedure
PROCEDURE
  • Assessments were conducted at three time points:
    • Pre-treatment.
    • Post-treatment.
    • 3-month follow-up.
  • All patients received 14 90-minute CBT sessions over 3 weeks (abbreviated intensive outpatient).
results continued
RESULTS (continued)
  • Using very strict criteria, 86% (6/7) were significantly improved at post-treatment assessment and 50% (3/6) at follow-up.
  • 71% (5/7) no longer met criteria for OCD at post-treatment and 50% (3/6) at follow-up.
take home points
TAKE HOME POINTS
  • CBT should be part of the treatment of PANDAS/PANS.
    • Despite etiological factors, rituals still reduce anxiety which reinforce further symptoms.
    • Very few doubt that OCD is caused by a neurobiological abnormality yet CBT works very well for it.
  • Family involvement is huge – parents as therapist model.
    • Empowers families.
    • May reduce impact of future bouts.
  • Can use other CBT interventions to treat other symptoms (e.g., habit reversal training for tics).
ad